The C3 cruciate pulley is the most distal of the three cruciate pulleys, located just proximal to the A5 pulley over the distal middle phalanx, completing the digital flexor sheath.
Provides the distal cruciate sheath support before the A5 pulley, allows sheath folding during distal joint flexion, and completes the fibrous tunnel enclosing the FDP tendon to the DIP joint.
The C3 pulley is the smallest and least clinically significant cruciate pulley. It is routinely divided during zone I tendon repair without consequence. The A2 and A4 annular pulleys are the critical functional pulleys requiring preservation.
Division of the C3 cruciate pulley during distal finger zone I FDP laceration repair, acceptable without tendon bowstringing as the A5 pulley provides adequate distal constraint.
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